卵泡期高孕激素状态下促排卵方案在卵巢低反应患者中的应用

目的探讨卵泡期高孕激素状态下促排卵(PPOS)方案在卵巢低反应(POR)患者中的应用价值。方法将行IVF/ICSI治疗的POR不孕症患者随机分为卵泡期PPOS方案组(n=79)和拮抗剂方案组(n=77),观察患者扳机日血清FSH、LH、E2、孕酮(P)水平,以及获卵数、成熟卵数、可用胚胎数、单周期促排卵平均用药费用等和随后冻融胚胎移植(FET)周期的妊娠结局。结果 PPOS方案组患者扳机日FSH、LH、E2、P水平与拮抗剂组相似(P0.05),获卵数、成熟卵数、可用胚胎数稍高于拮抗剂方案组[分别为(3.42±2.00)vs.(3.24±1.91)、(2.91±2.03)vs.(2.69±1.81)、(2.08±1.83)vs.(1.94±1.46)],但无统计学差异(P0.05);PPOS方案组单周期促排卵平均用药费用显著低于拮抗剂方案组[(1 990±1 045)vs.(3 925±745),P0.05);随后的FET周期中,PPOS方案组临床妊娠率、植入率、持续妊娠率均稍高于拮抗剂方案组[分别为(24.24%vs.22.86%、15.38%vs.13.24%、75.00%vs.62.50%),而流产率则低于拮抗剂组(25.00%vs.37.50%),但均无统计学差异(P0.05)。结论卵泡期应用高孕激素状态下促排卵方案可有效抑制LH峰,获得具有发育潜能的胚胎,与以往POR患者促排方案的胚胎实验室及临床结局比较无显著差异,但更为经济简便,为POR患者提供了一种新的选择。

Clinical study of progestin-primed ovarian stimulation during follicular phase in patients with poor ovarian response

Objective: To investigate the effect of the follicular phase of the progestin-primed ovarian stimulation(PPOS) in poor ovarian responders(PORs) undergoing IVF.Methods: A prospective study was performed for 156 infertility patients with PORs undergoing IVF/ICSI.The patients were randomly divided into two groups:79 patients adopted PPOS protocol and 77 patients adopted antagonist protocol.The levels of FSH,LH,E2 and progesterone on trigger day were measured during ovarian stimulation in two groups.The following data including number of oocytes retrieved,number of mature oocytes,number of available embryos,average cost of gonadotropin used per cycle and subsequent pregnancy outcome of frozen-thawed(FET) cycles were compared between the two groups.Results: The levels of FSH,LH,E2,progesterone on trigger day in PPOS group were not significantly different with the antagonist group.The number of oocytes retrieved[(3.42±2.00) vs.(3.24±1.91)],number of mature oocytes[(2.91±2.03) vs.(2.69±1.81)],number of available embryos[(2.08±1.83) vs.(1.94±1.46)] in PPOS group were higher than the antagonist group,but there were no significant differences(P＞0.05).The average cost of gonadotropin used per cycle for PPOS group was significantly lower than that of antagonist group[(1 990±1 045) RMB vs.(3 925±745)RMB](P＜0.05).No significant differences were found in the clinical pregnancy rate(24.24% vs.22.86%),the implantation rate(15.38% vs.13.24%) and ongoing pregnancy rate(75.00% vs.62.50%)in subsequent frozen-thawed embryo transfer cycle between the two groups.The abortion rate was slightly higher with no significant difference in antagonist group(25.00% vs.37.50%)(P＞0.05).Conclusions: The progestin-primed ovarian stimulation in the follicular phase can effectively suppress the premature LH surge,and has no significant difference in the laboratory indications and clinical outcomes compared with the antagonist protocol in POR patients.However,it is more economical.The progestin-primed ovarian stimulation in follicular phase provides a new choice of ovarian stimulation scheme for PORs in clinical practice.